Provider Demographics
NPI:1003839150
Name:BLAIR, JODI A (RRT)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:A
Last Name:BLAIR
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7580 TOSCANA BLVD
Mailing Address - Street 2:# 831
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5525
Mailing Address - Country:US
Mailing Address - Phone:407-370-0155
Mailing Address - Fax:
Practice Address - Street 1:1051 W DONEGAN AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2213
Practice Address - Country:US
Practice Address - Phone:407-343-8344
Practice Address - Fax:407-343-8565
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT14042279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884477100Medicaid